Chapter

Neurotrauma Management for the Severely Injured Polytrauma Patient

pp 29-44

Date:

Prehospital Care and EMS Considerations in the Polytrauma Patient with CNS Injuries

  • Dan B. AvstreihAffiliated withDept. of Emergency Medicine, Inova Fairfax HospitalThe George Washington University School of MedicineFairfax County Fire & Rescue Department, Inova Health SystemVirginia Commonwealth University School of Medicine Email author 
  • , Scott D. WeirAffiliated withDept. of Emergency Medicine, Inova Fairfax HospitalThe George Washington University School of MedicineFairfax County Fire & Rescue Department, Inova Health System

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Abstract

Emergency Medical Services (EMS) personnel are often the first medical providers to care for the polytrauma patient with traumatic brain injury. The prehospital environment brings with it unique technical and logistical challenges, as well as safety risks to providers, rarely encountered in hospital medicine. This chapter begins by describing the origins and structure of emergency medical services in the United States, followed by an outline of some of the inherent operational challenges of trauma care in the prehospital environment. The current tenets of EMS trauma care are discussed broadly, followed by a focused discussion on the management of polytrauma patients with traumatic brain injury. Controversies and areas for further research, including rapid sequence intubation, the utility of the prehospital GCS score, resuscitation endpoints, and the diagnosis and management of herniation syndromes, are explored in detail. The chapter ends with a discussion of best practices in EMS-hospital handoff and multidisciplinary quality improvement.

Keywords

Emergency medical services Prehospital Paramedic Aeromedical services Helicopter emergency medical services Trauma Prehospital trauma life support International trauma life support Traumatic brain injury Resuscitation endpoint Rapid sequence intubation Capnography Targeted hyperventilation Airway management Glascow coma score Simplified motor score Trauma triage guidelines Injury severity score Handoff